Department of Neurology, School of Medicine, Kyungpook National University, Daegu, Republic of Korea.
Department of Neurosurgery, School of Medicine, Kyungpook National University, Daegu, Republic of Korea.
Acta Neurochir (Wien). 2021 Jun;163(6):1787-1797. doi: 10.1007/s00701-021-04787-2. Epub 2021 Mar 15.
Angiographic outcomes of contact aspiration thrombectomy (CAT), a frontline thrombectomy strategy, can vary depending on balloon guide catheter (BGC) usage, stroke etiology, and occlusion location. The purpose of this study was to analyze conditional outcomes of CAT to determine which result in maximum angiographic benefits.
Patients who received CAT for anterior circulation occlusive stroke between January 2017 and December 2018 were included. Angiographic and clinical outcomes were compared relative to BGC use, stroke etiology, and occlusion location. Multivariable analyses for first-pass reperfusion (FPR) and favorable clinical outcome were performed.
Of 160 included patients, the rates of FPR, successful reperfusion after CAT, final successful reperfusion, and favorable clinical outcome were 43.1%, 58.1%, 81.9%, and 60.6%, respectively. BGC use was associated with a higher rate of FPR, successful reperfusion after CAT, a lower rate of distal embolization, and faster reperfusion. Based on subgroup analysis, BGC usage in ICA, MCA M1 occlusion, and cardioembolism were associated with higher FPR, successful reperfusion after CAT, and lower distal embolization. Faster reperfusion was achieved in ICA occlusions and cardioembolisms. BGC usage was an independent predictor of FPR. Favorable clinical outcome was associated with male gender, low initial NIHSS score, fast onset to reperfusion, and FPR.
In CAT, BGC usage was associated with better angiographic outcomes, including higher FPR, successful reperfusion after CAT, prevention of distal embolization, and faster reperfusion, especially in proximal occlusions and cardioembolisms. These conditions may play a role in maximizing the benefits of CAT.
接触抽吸血栓切除术（CAT）作为一线血栓切除术策略，其血管造影结果可能因球囊引导导管（BGC）的使用、卒中病因和闭塞部位而有所不同。本研究旨在分析 CAT 的条件结果，以确定哪种结果能带来最大的血管造影益处。
纳入 2017 年 1 月至 2018 年 12 月期间接受 CAT 治疗的前循环闭塞性卒中患者。比较 BGC 使用、卒中病因和闭塞部位与血管造影和临床结果的关系。对初次通过再灌注（FPR）和良好临床结局进行多变量分析。
160 例纳入患者中，FPR、CAT 后成功再灌注、最终成功再灌注和良好临床结局的比例分别为 43.1%、58.1%、81.9%和 60.6%。BGC 使用与更高的 FPR、CAT 后成功再灌注、更低的远端栓塞率和更快的再灌注有关。基于亚组分析，BGC 在 ICA、MCA M1 闭塞和心源性栓塞中的使用与更高的 FPR、CAT 后成功再灌注和更低的远端栓塞有关。ICA 闭塞和心源性栓塞中更快地实现了再灌注。BGC 使用是 FPR 的独立预测因子。良好的临床结局与男性、较低的初始 NIHSS 评分、快速开始再灌注和 FPR 有关。
在 CAT 中，BGC 使用与更好的血管造影结果相关，包括更高的 FPR、CAT 后成功再灌注、预防远端栓塞和更快的再灌注，尤其是在近端闭塞和心源性栓塞中。这些条件可能在最大限度地提高 CAT 的益处方面发挥作用。
